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Natural History and Prognosis of Splenomegaly in Schistosomiasis Mansoni

Past history in a group of 159 individuals with schistosomal splenomegaly revealed hematemesis in 12.6 percent and ascites, edema and/or jaundice in 1.9 percent. One hundred nine patients were followed for an average of 3.6 years. During this time liver failure was observed in eight and hematemesis in eleven (five of these had experienced bleeding prior to the beginning of the study). Liver failure was more often lethal than was gastrointestinal hemorrhage, death in the latter usually occurring after a series of such events.

Fifteen (9.4%) patients died during follow-up. Death occurred in four shortly after a voluminous hematemesis; in five it was a result of liver failure and in six it was the result of other diseases or accidents.

Since the complications of schistosomal splenomegaly are not as frequent as they are in other diseases leading to portal hypertension, we believe that the policy of prophylactic venous shunts in individuals who have never experienced hematemesis should be seriously questioned.